Showing papers by "John R. Hurst published in 2009"

exacerbation rate, health status and mortality in COPD - a review of potential interventions

Abstract: COPD is prevalent in Western society and its incidence is rising in the developing world. Acute exacerbations of COPD, about 50% of which are unreported, lead to deterioration in quality of life and contribute significantly to disease burden. Quality of life deteriorates with time; thus, most of the health burden occurs in more severe disease. COPD severity and frequent and more severe exacerbations are all related to an increased risk of mortality. Inhaled corticosteroids (ICS) have similar effects on quality of life but ICS/long-acting bronchodilator combinations and the long-acting antimuscarinic tiotropium all improve health status and exacerbation rates and are likely to have an effect on mortality but perhaps only with prolonged use. Erythromycin has been shown to decrease the rate of COPD exacerbations. Pulmonary rehabilitation and regular physical activity are indicated in all severities of COPD and improve quality of life. Noninvasive ventilation is associated with improved quality of life. Long-term oxygen therapy improves mortality but only in hypoxic COPD patients. The choice of an inhaler device is a key component of COPD therapy and this requires more attention from physicians than perhaps we are aware of. Disease management programs, characterized as they are by patient centeredness, improve quality of life and decrease hospitalization rates. Most outcomes in COPD can be modified by interventions and these are well tolerated and have acceptable safety profiles.

Management and prevention of chronic obstructive pulmonary disease exacerbations: a state of the art review

Abstract: Exacerbations of chronic obstructive pulmonary disease (COPD) are important events in the natural history of this prevalent and devastating condition. This review provides a concise, state of the art summary on prevention and management of exacerbations. Considerable new data underpins evidence in support of many preventative interventions, pharmacological and non-pharmacological, that are now available. Challenges remain in developing new approaches, and delivering those that already exist to the right patient at the right time. Management of an exacerbation remains stepwise according to clinical severity, but there is now additional focus on addressing comorbidities and taking the opportunity at acute events to optimise preventative strategies for the future. Ultimately, exacerbations are heterogeneous events in a heterogeneous disease, and an individualised approach is paramount.

UK national survey of current practice and experience of intravitreal triamcinolone acetonide.

Abstract: In recent years, intravitreal triamcinolone acetonide (IVTA) injections have become widely used in the treatment of macular oedema. IVTA can cause elevation of intraocular pressure (IOP), which can be sight threatening. We carried out a nationwide study, which aimed to (i) assess the current usage of IVTA, (ii) estimate the incidence of ‘severe’ IOP rise following IVTA, in routine practice. A postal survey was carried out in January 2007. A questionnaire was mailed to senior ophthalmologists (all consultants and associate specialists) in the United Kingdom. We asked about the use of IVTA over the past year and whether there had been any cases of severe IOP rise (defined as elevation in IOP, commencing after IVTA therapy, requiring laser or surgery to treat the raised pressure). Response rate was 56% (611/1089). Among respondents, 33% (206) had used IVTA during the 12 months of 2006 giving a total of 3899 IVTA injections. There were 45 reported cases of severe IOP rise, following IVTA injections, which were given under their care of the respondent. A further 28 cases were reported to have been referred from colleagues; it is unclear whether any or all of these cases were included in the initial 45. The reported rate of severe IOP rise following IVTA was therefore at least 45/3899 or at least 1.1%. Usage of IVTA in the United Kingdom is widespread. Severe IOP rise, requiring laser or surgery to control IOP, was reported in at least 1.1% of cases.

Westermark’s sign in submassive pulmonary embolism

Abstract: A previously fit 72-year-old woman presented after an episode of syncope. She was alert but dyspnoeic, with a respiratory rate of 36 breaths per minute and an oxygen saturation of 81% breathing room air. Her pulse was 86 …